The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma

Abstract

Aim: To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment.

Methods: A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT.

Results: A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post-treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51-0.79; p < 0.001) as well as of post-treatment mortality (OR: 0.54; 95%CI = 0.35-0.83; p = 0.006).

Conclusions: Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment.

Keywords: aspirin; clopidogrel; incidence; occurrence; survival.

FIGURE 1

PRISMA summarizing the trial flows for HCC incidence and occurrence

FIGURE 2

Forest plot and meta‐analysis showing the positive correlation between the use of APT and the reduced risk of HCC incidence. APT, anti‐platelet therapy; HCC, hepatocellular carcinoma

FIGURE 3

Forest plot and meta‐analysis showing the positive correlation between the use of APT and the reduced risk of overall death after any HCC treatment. APT, anti‐platelet therapy; HCC, hepatocellular carcinoma

FIGURE 4

Figure reporting the mechanisms connected between platelets and HCC growth and spread, and the consequent beneficial effect of blocking these mechanisms driven by the APT. Figure modified by Lai Q, et al. (Ref. 3)